The real health concern

0 Comments | Deseret News (Salt Lake City), Apr 27, 2009

The following editorial appeared in the Boston Globe:

As the country edges toward full computerization of medical records, most of the objections have focused on potential breaches of privacy. Beth Israel Deaconess has stumbled on a different problem in its tie-in with Google Health: accuracy.

Google, Microsoft, and other companies offer consumers a voluntary, cost-free means of creating a personal health record accessible over the Internet and usable, with the patient's OK, by health-care providers. But Beth Israel discovered that using insurance claims data can sometimes provide false information because of misinterpretations of insurance codes. The hospital has sensibly decided to stop using such data. For its part, Google, which says it will "listen and improve Google Health based on what users teach us," should stop accepting insurance claims data from its partner hospitals.

President Barack Obama included $17 billion in his stimulus package to begin the process of weaning medicine nationwide from prescription pads and paper records. With full computerization, doctors could be nudged toward best practices and get alerts, for example, before they prescribe a drug to which the patient is allergic or where a harmful drug interaction may occur. For patients seeking to get ahead of the curve on computerization, Google Health and the other companies provide that opportunity.

The diagnostic codes that insurers require doctors to use would appear to be a convenient way to convey patients' conditions in the profiles. But it turns out that the coding is not always exact enough to describe a patient's precise malady, nor does it indicate the severity of a condition. Also, doctors often use these diagnostic codes to describe tests for specific diseases, but a computerized profile may not specify when the results turn out negative. Some patients are therefore listed as suffering from ailments that they don't actually have.

Beth Israel said it will now send to Google Health written text descriptions of patients' medical problems. While the coded format made it especially easy for the Web site to refer patients to other medical Web sites for information about their conditions, Beth Israel's chief information officer, Dr. John Halamka, said that such linkage will still be possible for most of the medical terms in the hospital's records.

In any case, the ease of linkage to other sites should not be the prime consideration in the design and operation of patients' personal profiles. If they are to help patients and their doctors make treatment decisions, especially in emergency conditions, the profiles must contain no inaccurate information. Cutting corners by using insurance claims data should be no one's idea of a best practice in medical information technology.